Maryland became the 18th state to legally recognize naturopathic medicine last week when Gov. Martin O'Malley signed a law allowing naturopathic doctors (NDs) to become licensed health care practitioners.

The law gives citizens a new option for family health care. It also protects citizens by distinguishing licensed NDs — who attend four to five years of accredited graduate training and pass rigorous professional licensing exams — from unlicensed practitioners without such training.

“The new law continues the movement to bring emerging professions such as naturopathic medicine into the medical mainstream,” Jud Richland, chief executive of the American Association of Naturopathic Physicians (AANP), said in a news release. "Patients are increasingly demanding the kind of whole-person care delivered by naturopathic doctors."

Naturopathic medicine is a distinct system of health care that emphasizes prevention and the healing power of nature through therapies such as nutrition, counseling, botanical medicine and physical medicine. Maryland follows Colorado, which offered legal recognition for NDs in June 2013. Lawmakers in Massachusetts, Pennsylvania and Rhode Island are also considering licensure bills this year, Richland said.

"The law is a continuation of a growing recognition that naturopathic medicine is an effective form of medicine," Richland said. "I think that's why we're seeing so many states getting close to the finish line of legal recognition."

The law capped a multiyear campaign by Maryland NDs who built support among patients, lawmakers, conventional-medicine practitioners and key leaders in the state. The Maryland Department of Health and Mental Hygiene reversed its initial opposition and supported the final bill. The Maryland State Medical Society also withdrew its opposition. Peter Beilenson, MD, a former commissioner of the Baltimore and Howard County health departments, current chief executive of the Evergreen Healthcare Co-Op and an influential voice on health policy, also wrote in support of the bill.

The Maryland Association of Naturopathic Physicians worked with a lobbyist to show lawmakers how access to NDs would expand health care options in the state.

"We decided early on we would keep our message positive at all times, even in the face of strong opposition," said Emily Telfair, ND ('05), president of the state association. "We just kept coming back, stronger and stronger, with more evidence supporting our case and more relationships with the conventional-medicine community."

The law gives NDs the right to diagnose and treat illness, perform physical examinations and order lab tests and diagnostic imaging. It sets up an advisory committee under the Maryland Board of Physicians that will supervise the profession, with the first licenses to be granted in early 2016. The law limits some parts of the naturopathic scope of practice — such as intravenous (IV) therapies and prescription drugs — that the state association will work to secure in the future. Other states such as California have gained licensure and then expanded their scope in following years.

"The law is a great demonstration of what happens when a state naturopathic association puts its mind to getting the job done, and is persistent and politically savvy at the same time," said Richland.

In working with lawmakers, Dr. Telfair said that many were interested in the growing use of alternative health care among Americans.

"As one legislator put it, people are seeking out this care whether we license it or not," she said. "It's so important, if people use natural supplements and therapies, that we have licensed professionals who are guiding them with good information."

"Through this journey, I've been thinking about future students," she said. "I have a number of young people visit my office because they're thinking about studying naturopathic medicine. For the country, any time we get another state licensed, hopefully it's a tipping point toward even more state recognition. This sets in motion something that's so much bigger than us."